Mar 14, 2017

Bethany Pray serves as CCLP's Chief Legal and Policy Officer. Her areas of expertise include regulatory analysis and advocacy for Medicaid and commercial coverage, access to behavioral health benefits, Medicaid eligibility and much more.Staff page ›

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What the CBO score means for CO

by | Mar 14, 2017

In a report released on Monday, the Congressional Budget Office and the staff of the Joint Committee on Taxation estimated that the House Republicans’ American Health Care Act would increase the number of uninsured Americans by 24 million over the next 10 years, result in big reductions in assistance for lower-income consumers who purchase insurance on state or federal exchanges, and lead to a precipitous 25 percent drop in federal funding for Medicaid over 10 years. CCLP’s fact sheet covers the details.

The short-term changes from the Act would be significant. With 14 million Americans projected to be uninsured just one year from now, approximately 238,000 more Coloradans could lose or forgo coverage. The repeal of the mandate to purchase insurance would be one factor in people’s decision-making. Those most likely to drop coverage would be younger Coloradans, while those with greater health needs would have reason to stay in. When carriers have to pay more for a typical enrollee, they raise premiums. That shift in the health status of those who are covered is projected to increase premium rates in 2018 and 2019 by 15 to 20 percent. These and successive drops in coverage will return Colorado to a scenario where hospitals must cover increasing amounts of uncompensated care, and that drives up costs for everyone.

The major changes to the market and Medicaid would begin in 2020. Premium assistance would be too meager to allow those with less income to purchase and use coverage — especially in more expensive areas like the Western Slope. Older Coloradans would have to pay more than five times the premium cost of younger residents, and would get only twice the amount of premium assistance, leading to particularly high rates of drop-out. Areas that have higher percentages of residents ages 50-64 would suffer, such as the southwest and northwest corners of the state. Although skimpier plans may result in lower premiums, those who get medical care will have to wrangle with higher deductibles and cost-sharing.

But the big story is Medicaid. Health First Colorado, our state Medicaid program, could lose 25 percent of its funding by 2026 because of changes in the way federal funding is provided through the plan. Instead of a flexible matching system that allows Colorado to respond to need, the Act would impose a system that caps per enrollee spending and limits the annual growth of that per-capita cap.  A funding cut of that size would require dramatic reductions in benefits to children, the elderly, people with disabilities, and parents.

For adults who received coverage from the Medicaid expansion–those without children as well as parents who make over 66 percent of the federal poverty limit –  the cuts would be much deeper. Instead of covering almost all expansion costs, the federal government would give Colorado no more than 50 percent for new adult enrollees and adults who temporarily lost Medicaid coverage and reenrolled. To cover those individuals, Colorado would have to kick in roughly $800 million a year. More likely, Health First Colorado would have to drop many of these adults altogether.  Furthermore, expansion dollars are a primary source of funding in the battle against opioid addiction, and the loss of those funds would hamper those efforts.

What is left unsaid in the CBO report is the effect on state and local economies. Coloradans with higher incomes will get hefty tax breaks while older Coloradans, rural Coloradans and lower-income Coloradans will feel the impact of the new, inadequate tax credits. Tens of thousands would lose Medicaid.  Colorado won’t benefit from a system that reduces jobs in the health sector, that threatens to shutter rural hospitals, and that endangers the health of working Coloradans.

To ensure that Coloradans continue to have access to quality, affordable health care, please make your concerns known to members of Colorado’s Congressional delegation. You can also learn how to get involved through the Protect Our Care Colorado website.

– Bethany Pray

Recent articles

CCLP’s 2024 legislative wrap-up, part 2

CCLP's 2024 legislative wrap-up focused on expanding access to justice, removing administrative burden, supporting progressive tax and wage policies, preserving affordable communities, and reducing health care costs. Part 2/2.

CCLP’s 2024 legislative wrap-up, part 1

CCLP's 2024 legislative wrap-up focused on expanding access to justice, removing administrative burden, supporting progressive tax and wage policies, preserving affordable communities, and reducing health care costs.

HEALTH:
HEALTH FIRST COLORADO (MEDICAID)

To maintain health and well-being, people of all ages need access to quality health care that improves outcomes and reduces costs for the community. Health First Colorado, the state's Medicaid program, is public health insurance for low-income Coloradans who qualify. The program is funded jointly by a federal-state partnership and is administered by the Colorado Department of Health Care Policy & Financing.

Benefits of the program include behavioral health, dental services, emergency care, family planning services, hospitalization, laboratory services, maternity care, newborn care, outpatient care, prescription drugs, preventive and wellness services, primary care and rehabilitative services.

In tandem with the Affordable Care Act, Colorado expanded Medicaid eligibility in 2013 - providing hundreds of thousands of adults with incomes less than 133% FPL with health insurance for the first time increasing the health and economic well-being of these Coloradans. Most of the money for newly eligible Medicaid clients has been covered by the federal government, which will gradually decrease its contribution to 90% by 2020.

Other populations eligible for Medicaid include children, who qualify with income up to 142% FPL, pregnant women with household income under 195% FPL, and adults with dependent children with household income under 68% FPL.

Some analyses indicate that Colorado's investment in Medicaid will pay off in the long run by reducing spending on programs for the uninsured.

FOOD SECURITY:
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP)

Hunger, though often invisible, affects everyone. It impacts people's physical, mental and emotional health and can be a culprit of obesity, depression, acute and chronic illnesses and other preventable medical conditions. Hunger also hinders education and productivity, not only stunting a child's overall well-being and academic achievement, but consuming an adult's ability to be a focused, industrious member of society. Even those who have never worried about having enough food experience the ripple effects of hunger, which seeps into our communities and erodes our state's economy.

Community resources like the Supplemental Nutrition Assistance Program (SNAP), formerly known as Food Stamps, exist to ensure that families and individuals can purchase groceries, with the average benefit being about $1.40 per meal, per person.

Funding for SNAP comes from the USDA, but the administrative costs are split between local, state, and federal governments. Yet, the lack of investment in a strong, effective SNAP program impedes Colorado's progress in becoming the healthiest state in the nation and providing a better, brighter future for all. Indeed, Colorado ranks 44th in the nation for access to SNAP and lost out on more than $261 million in grocery sales due to a large access gap in SNAP enrollment.

See the Food Assistance (SNAP) Benefit Calculator to get an estimate of your eligibility for food benefits.

FOOD SECURITY:
SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN (WIC)

Every child deserves the nutritional resources needed to get a healthy start on life both inside and outside the mother's womb. In particular, good nutrition and health care is critical for establishing a strong foundation that could affect a child's future physical and mental health, academic achievement and economic productivity. Likewise, the inability to access good nutrition and health care endangers the very integrity of that foundation.

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) provides federal grants to states for supplemental foods, health care referrals, and nutrition information for low-income pregnant, breastfeeding and non-breastfeeding postpartum women and to infants and children up to age five who are found to be at nutritional risk.

Research has shown that WIC has played an important role in improving birth outcomes and containing health care costs, resulting in longer pregnancies, fewer infant deaths, a greater likelihood of receiving prenatal care, improved infant-feeding practices, and immunization rates

Financial Security:
Colorado Works

In building a foundation for self-sufficiency, some Colorado families need some extra tools to ensure they can weather challenging financial circumstances and obtain basic resources to help them and their communities reach their potential.

Colorado Works is Colorado's Temporary Assistance for Needy Families (TANF) program and provides public assistance to families in need. The Colorado Works program is designed to assist participants in becoming self-sufficient by strengthening the economic and social stability of families. The program provides monthly cash assistance and support services to eligible Colorado families.

The program is primarily funded by a federal block grant to the state. Counties also contribute about 20% of the cost.

EARLY LEARNING:
COLORADO CHILD CARE ASSISTANCE PROGRAM (CCCAP)

Child care is a must for working families. Along with ensuring that parents can work or obtain job skills training to improve their families' economic security, studies show that quality child care improves children's academic performance, career development and health outcomes.

Yet despite these proven benefits, low-income families often struggle with the cost of child care. Colorado ranks among the top 10 most expensive states in the country for center-based child care. For families with an infant, full-time enrollment at a child care center cost an average of $15,140 a year-or about three-quarters of the total income of a family of three living at the Federal Poverty Level (FPL).

The Colorado Child Care Assistance Program (CCCAP) provides child care assistance to parents who are working, searching for employment or participating in training, and parents who are enrolled in the Colorado Works Program and need child care services to support their efforts toward self-sufficiency. Most of the money for CCCAP comes from the federal Child Care and Development Fund. Each county can set their own income eligibility limit as long as it is at or above 165% of the federal poverty level and does not exceed 85% of area median income.

Unfortunately, while the need is growing, only an estimated one-quarter of all eligible children in the state are served by CCCAP. Low reimbursement rates have also resulted in fewer providers willing to accept CCCAP subsidies.